Care Manager

3 weeks ago


Long Beach, California, United States Blue Shield of California Full time
About the Role

Blue Shield of California is seeking a highly skilled and experienced Care Manager to join our team. As a Care Manager, you will play a critical role in ensuring that our members receive high-quality, patient-centered care.

Key Responsibilities
  • Develop and Implement Care Plans: Research and design treatment/care plans to promote quality of care and cost-effective healthcare services based on medical necessity.
  • Coordinate Care Services: Initiate timely individualized care plans (ICPs) based on health risk assessments (HRAs), participate in and document interdisciplinary meetings (IDMs), and assist in transitions of care across all ages.
  • Referral and Authorization: Determine the appropriateness of referrals for CM services, mental health, and social services, and provide referrals to Quality Management (QM), Disease Management (DM), and Appeals and Grievance departments (AGD).
  • Member Care Review: Conduct member care reviews with medical groups or individual providers for continuity of care, out-of-area/out-of-network, and investigational/experimental cases.
  • Treatment Management: Manage member treatment to meet recommended length of stay, ensure DC planning at levels of care appropriate for member needs and acuity, and assess member health behaviors, cultural influences, and client belief/value systems.
Requirements
  • Current CA RN License
  • Bachelor's of Science in Nursing or Advanced Degree
  • 5+ Years' Experience in Nursing, Healthcare, or Related Field
  • 3+ Years Managed Care Experience
  • Certified Case Manager (CCM) Certification
  • Excellent Communication Skills
What We Offer

Blue Shield of California offers a competitive salary range of $ to $ for this role, based on experience and location. We also offer a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan and paid time off.


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